CurrentHumanaPolicy CP2026005

Modifiers for Occupational Therapy, Physical Therapy and Speech Language Pathology

Defines Humana Kentucky Medicaid billing requirements for reporting modifiers that identify occupational therapy, physical therapy, and speech-language pathology services and whether services are habilitative or rehabilitative.

Policy Summary

PayerHumana

PolicyModifiers for Occupational Therapy, Physical Therapy and Speech Language Pathology

Policy CodePolicy CP2026005

Change TypeNo material change

Effective Date04/2026

Next Review Date

Key ActionReport GN for speech language pathology, GO for occupational therapy, GP for physical therapy and report 96 for habilitative services or 97 for rehabilitative services.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

3therapy discipline modifiers required (GN, GO, GP)

2service purpose modifiers required (96 habilitative, 97 rehabilitative)

Kentucky Medicaidapplicability

Modifier Reporting and Claims Processing

Modifier reporting and claims processing

Billing requirements for modifier reporting; claims remain subject to medical necessity, referral/authorization and other plan requirements.

ALL of the following

ALL of the following
- ONE of
  - Report modifier GN for a speech language pathology service.
  - Report modifier GO for an occupational therapy service.
  - Report modifier GP for a physical therapy service.
ALL of the following

Policy Summary

PayerHumana

PolicyModifiers for Occupational Therapy, Physical Therapy and Speech Language Pathology

Policy CodePolicy CP2026005

Change TypeNo material change

Effective Date04/2026

Next Review Date

Key ActionReport GN for speech language pathology, GO for occupational therapy, GP for physical therapy and report 96 for habilitative services or 97 for rehabilitative services.

SourceLink

On This Page

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Required Modifier Reporting (Provider Actions)

Billing Rule

Report therapy discipline and service-purpose modifiers on claims

Humana requires providers to report discipline and purpose modifiers on claims: use GN for speech‑language pathology, GO for occupational therapy, and GP for physical therapy; use 96 to indicate habilitative services and 97 to indicate rehabilitative services. Claims remain subject to other plan requirements such as medical necessity and referral/authorization rules.

Report modifier GN for a speech language pathology service
Report modifier GO for an occupational therapy service
Report modifier GP for a physical therapy service
Report modifier 96 for a habilitative service
Report modifier 97 for a rehabilitative service

Modifier Definitions

inv-04: Modifier 96 — Habilitative services

Modifier96

DefinitionHabilitative services

ContextUsed to identify services provided for habilitation as defined in Humana Kentucky Medicaid policy

inv-05: Modifier 97 — Rehabilitative services

Modifier97

DefinitionRehabilitative services

ContextUsed to identify services provided for rehabilitation as defined in Humana Kentucky Medicaid policy

inv-06: Modifier GN — Services delivered under an outpatient speech language pathology plan of care

ModifierGN

DefinitionServices delivered under an outpatient speech language pathology plan of care

UseReport GN to identify speech-language pathology services on claims

inv-07: Modifier GO — Services delivered under an outpatient occupational therapy plan of care

ModifierGO

DefinitionServices delivered under an outpatient occupational therapy plan of care

UseReport GO to identify occupational therapy services on claims

inv-08: Modifier GP — Services delivered under an outpatient physical therapy plan of care

ModifierGP

DefinitionServices delivered under an outpatient physical therapy plan of care

UseReport GP to identify physical therapy services on claims

OpenPayer

Modifiers for Occupational Therapy, Physical Therapy and Speech Language Pathology

Modifier Reporting and Claims Processing

Therapy Discipline and Purpose Modifiers

Required Modifier Reporting (Provider Actions)

Modifier Definitions

GN	Services delivered under an outpatient speech language pathology plan of care
GO	Services delivered under an outpatient occupational therapy plan of care
GP	Services delivered under an outpatient physical therapy plan of care
96	Habilitative services
97	Rehabilitative services